Healthcare Provider Details

I. General information

NPI: 1902823933
Provider Name (Legal Business Name): MS. MIRIAM ERPENBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRIAM MAKEL M.A., LVN

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

44 CACHE RIVER CIR
SACRAMENTO CA
95831-3755
US

V. Phone/Fax

Practice location:
  • Phone: 916-591-0385
  • Fax: 916-874-9442
Mailing address:
  • Phone: 916-421-2196
  • Fax: 916-421-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN207412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: